I am 44 yrs old and have yearly pap smears and mamograms. This year my pap smear came back with "atypical cells". The nurse said my doctor would repeat pap in 4 mths. What does that actually mean (atypical cells) ? My mamogram came back with what appears to be a mass in my left breast. I am to have a sonogram soon. Do you think it is a good idea to have the CA blood test?

Response from Dr. Dezube

An annual Pap test is the best way to screen women for cervical cancer. Nearly all cervical cancers are thought to arise from certain strains of HPV (human papillomavirus, also known as the wart virus). Two million US women each year get the most common abnormal Pap result, called ASCUS, or atypical cells of undetermined significance.

What to do with the ASCUS results? Many experts would recommend that you get HPV testing. This is no more complicated than a Pap test. Cells are collected and tested to determine what strain of HPV you have. Certain HPV strains are more worrisome than other HPV strains. If you have an HPV strain linked to cervical cancer (a more worrisome strain), then the the next step would be a culposcopy. Culposcopy is an examination of the cervix under a special microscopy during which biopsies are taken. If you have a not-so-worrisome HPV test, then culposcopy is not necessary.

So in short, I'd recommend HPV testing and depending upon the result you may need culposcopy. I should add that the HPV test is approved exactly for this situation-- to clarify ASCUS results.

For those of you who like to read medical literature, here's the reference: Journal of the American Medical Association, 2002;287:2372-2390 (two articles).

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